A removable 'permanent' tattoo ink?

Published 8:00 pm, Saturday, September 29, 2007

It is now reported that 30 percent of adults under the age of 35 have at least one tattoo. Many continue to enjoy their small, inconspicuous tattoo on the ankle, low back or abdomen. Others, however, are unhappy with the rash decision they made one night, after drinking a little too much, to have large tattoos placed on their neck, shoulders, upper chest and other more visible areas. At least once a week a patient in my office asks if I can remove a tattoo.

Virtually all tattoo dyes are made of insoluble pigment. The inks are complex and contain organic dyes, metals and solvents. They are not registered by the FDA. Some of the materials used are industrial-grade and are used in printer's ink or automobile paint. Some chemicals used for tattoos can break down in the sunlight and become carcinogenic. Cells deep within the skin "absorb" these inks and they are held in place for decades. Sometimes they may fade or change colors, but they are, in essence, there for the rest of a person's life.

Although tattooing is legal, laws vary regarding control of the practice. Most medical personnel are concerned about the significant health risks of being tattooed. Although sterile, single-use inks are available, they often are not used. Similarly, equipment used may not be sterilized appropriately between clients. These practices can lead to transmission of infectious diseases. A single tattoo increases the risk of hepatitis C by 6.5 times. HIV is another concern. Even when all precautions are taken, blood spatter during tattooing can contaminate the environment. Allergic reactions have been reported. Excessive scar formation (keloids) or an over-aggressive immune response (foreign body granuloma) can also occur.

Obviously, the size of the tattoo influences how difficult it is to remove. Smaller tattoos can be excised, resulting in minimal scarring. This is not possible with larger tattoos. Some medical procedures (infrared coagulation, electrocautery, CO2 vaporization, and dermabrasion) can remove the tattoo, but the patient is often left with a scar that appears much like a burn scar.

Most recently, Q-switched lasers have been used to remove tattoos. These lasers have a wavelength of light that is variable to accommodate the different colors in the tattoo. Q-switched lasers can remove most tattoos with minimal scarring, but the equipment is expensive and the procedure is time consuming. Black ink tattoos will require six to 12 treatments given at one-month intervals. Yellow, white, orange, purple and green pigments are more difficult, if not impossible, to remove even with a Q-switched laser. Other pigments that contain iron or titanium oxide (used for permanent eye or lip makeup) may actually darken with laser treatments.

New inks are now available for tattooing and are sold under the brand name "Freedom-2." The particles in these inks are extremely small and are made with tiny amounts of black iron, so that they are sensitive to the Q-switched lasers. Thus, they are "permanent" unless someone wants to remove them. The process of removal is what has been made easier. It's still a complicated process, but by using the laser on removable ink tattoos, the likelihood of success without scarring is improved.

Obtaining a tattoo does carry some medical risk. Removing traditional tattoos is extremely difficult unless multiple procedures with expensive lasers are used. New tattoo inks appear to be easier to remove, but their long-term safety still has not been established.

Dr. John L. Pfenninger's column appears on Sundays. His office, Medical Procedures Center, is located in Midland